Efficacy of Preemptive Dexamethasone versus Methylprednisolone in the Management of Postoperative Discomfort and Pain after Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis

Abstract

The corticosteroids have been used for preemptive management of surgical sequelae after mandibular third molar extraction. The aim of this article was to review the efficacy of methylprednisolone versus dexamethasone in the management of postsurgical pain, swelling, and trismus after mandibular third molar surgery. Randomized, double-blinded studies from PubMed, CINAHL, Scopus, DOSS, Cochrane central, and Web of Science were identified by using a search strategy. Randomized controlled trials evaluating the efficacy of use of dexamethasone versus methylprednisolone for mandibular third molar extraction were only considered. The studies involving the use of any other corticosteroid agent were excluded. Outcomes assessed were postoperative pain, the number of rescue analgesics required, swelling, trismus, and adverse events. The search strategy yielded 1046 articles for title and abstract screening, out of which only seven studies were included in the systematic review after full text screening. There was considerable heterogeneity between the studies with regards to the method as well as the parameters assessed. Risk of bias was low in three studies and unclear in other four studies. On pooled analyses, there was no significant difference with respect to pain, rescue analgesics, and swelling in the test and the control group. Forest plot analysis showed that dexamethasone had lesser trismus in early postoperative period (postoperative day 2) as compared to methylprednisolone. None of the included studies reported any adverse effects. Both the corticosteroids have similar efficacy in reducing the postoperative pain and swelling; however, dexamethasone showed statistically significant difference from methylprednisolone in reducing trismus (estimated standardized mean difference of −0.69 mm; 95% CI: −1.01 to −0.38; p < 0.0001 ) in the early postoperative period. However, due to statistical heterogeneity, quality of the evidence for the review was low to moderate. Hence, more studies with larger study sample and low risk of bias are needed to confirm these results.

Impact of Single-Session Intraoral and Extraoral Photobiomodulation on Pain Control after Extraction of Impacted Mandibular Third Molar: A Pilot Study

“…(1) This study was a single-center study, and a multicentric study with a larger sample size is needed to obtain concrete results. (2) This study was a controlled study, and adding a placebo group would give more concrete results due to eliminating the possible risk of bias that may occur. (3) Ensuring equality in the difficulty of surgical extraction between the two groups was only achieved by determining a time limit for the intervention and the standardization of the surgical intervention procedures by the same operator.…”

“…These complications may eventually have an impact on the patient's quality of life [1]. The postoperative patient discomfort might be due to triggering an inflammatory response [2].…”

“…The most intense pain is predicted in the first 12 h after surgery and may endure up to between the third and fifth day after surgery at a lower intensity [3]. The use of antiinflammatory agents, including non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, has been shown to be efficient in the management of these postoperative complications in general and pain in particular [2,4]. However, there are many reported side effects of the use of these drugs, such as gastrointestinal irritation, allergic reactions, or hemorrhagic complications.…”

Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial

“…The body naturally produces hydrocortisone (cortisol), with a typical daily production in an adult of between 15 and 30 mg, but it can be produced in amounts up to 300 mg in times of need [16,17]. Corticosteroids need to be administered at higher dosages than basal secretion in order to have an anti-inflammatory effect.…”

Adjuvant Analgesics in Acute Pain – Evaluation of Efficacy

“…Although there are a few trials suggesting that methylprednisolone might have analgesic properties when given perioperatively [67][68][69], and a recent systematic review and meta-analysis showed similar efficacy of methylprednisolone and dexamethasone in reducing postoperative pain after third molar surgery [70], most studies focused on dexamethasone as a possible adjuvant analgesic in the perioperative setting.…”